Differential relationships of systolic and diastolic blood pressure with components of left ventricular diastolic dysfunction

AIMS: To determine whether SBP or DBP is best associated with different components of left ventricular diastolic dysfunction. METHODS: In 241 randomly selected participants, echocardiographic left ventricular diastolic function was assessed from early-to-atrial (E/A) transmitral velocity and E/e' where e' represents myocardial tissue lengthening velocity in early diastole as measured at the mitral annulus. Relationships between diastolic function and blood pressure (BP) were assessed from brachial and central aortic (radial applanation tonometry and SphygmoCor software) measurements. RESULTS: Independent of confounders, brachial DBP (partial r = -0.21, P < 0.002), but not SBP (partial r = -0.09, P = 0.18), was associated with E/A and the relationship between brachial DBP and E/A persisted with adjustments for brachial (P < 0.002) or aortic (P < 0.05) SBP. Although aortic SBP was independently associated with E/A, this relationship did not persist with adjustments for DBP (partial r = -0.05, P = 0.44). In contrast, both brachial (partial r = 0.34, P < 0.0001) and aortic (partial r = 0.34, P < 0.0001) SBP were independently associated with E/e', effects that persisted with adjustments for DBP (P < 0.0001), although independent relationships between DBP and E/e' did not persist with adjustments for brachial or aortic SBP (P = 0.17-0.57). In quartiles of DBP or SBP within normal-to-high normal ranges, multivariate adjusted E/A was decreased and E/e' increased as compared with those with optimal BP values (P < 0.05 to P < 0.005). CONCLUSION: Both SBP and DBP are important determinants of separate components of left ventricular diastolic dysfunction and these effects are noted even within normotensive BP ranges. DBP may be as important as SBP in the transition to diastolic dysfunction.